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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336408433
Report Date: 01/05/2024
Date Signed: 01/05/2024 02:59:22 PM


Document Has Been Signed on 01/05/2024 02:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:VISTA COVE AT RANCHO MIRAGEFACILITY NUMBER:
336408433
ADMINISTRATOR:JACK POYFAIRFACILITY TYPE:
740
ADDRESS:70201 MIRAGE COVE DRIVETELEPHONE:
(760) 324-4604
CITY:RANCHO MIRAGESTATE: CAZIP CODE:
92270
CAPACITY:68CENSUS: 50DATE:
01/05/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Jack Poyfair, AdministratorTIME COMPLETED:
03:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit for the purpose of conducting a health and safety check. LPA Delgado met with Executive Director Jack Poyfair, explained the nature of the visit and was granted entry into the facility. LPA toured the facility with the ED. The LPA did not observe any health and safety concerns during the visit.

An exit interview was conducted where this report was provided to Jack Poyfair.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:
DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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